Why You're Breaking Out, According to a Derm
You aren't the only one suffering from more and more acne flare-ups. Here's why you're breaking out—plus what you can do to prevent and treat them.
It's been at least a decade (or two) since you were enduring the incredibly awkward, blackhead-filled life period known as puberty. But now, you're breaking out just as much as you did when you were 13. What gives?
Here, Karen Nern, M.D., a dermatologist and dermatologic surgeon in Colorado, discusses why you are breaking out, along with the lifestyle habits and quick fixes you can make to boost your skin health.
It seems that everyone is struggling with acne now—is that true?
We’re under chronic pressure these days. Partly because we’ve created an instant-feedback society with social media, which makes us worry about getting likes and how we look in photos. This intense climate means we’re constantly triggering our stress hormones, like cortisol, which drives oil production and causes acne. (BTW, stress isn't the only reason your acne might be flaring up.)
What kind of effect does acne have on your psyche?
Acne occupies so much mental space. Once the acne is successfully treated, that space becomes freed up to find more joy in life because we don’t spend time worrying that people are scrutinizing our face. Acne patients are some of my most rewarding. They’re devastated by their skin, feeling so self-conscious that they don’t make eye contact. When they’re clear, they become incredibly happy and confident. (Read the story of one woman who stayed in her home because of her severe acne.)
How to Clear Up Your Skin
What causes acne, exactly?
Acne results when the pores get closed over and the oil that’s backed up becomes infected. We want to do three things: Open the pores by exfoliating, kill the bacteria with a spot treatment like benzoyl peroxide, and reduce inflammation with antioxidants and vitamins in your moisturizer, which will keep your skin’s barrier intact and happy.
What's the best way to exfoliate?
We know you need to exfoliate to open the pores. There are so many new products with lactic, glycolic, or salicylic acid made for daily use that are great for gentle exfoliation. Once a week go for something stronger, like a glycolic peel pad. I love a monthly in-office treatment like the new Diamond Glow Facial, which can resurface the skin and get rid of some of the top dead layers but without downtime.
What’s the new frontier of acne control?
One ingredient we’re getting more information on is niacinamide, or vitamin B3. That’s a really interesting vitamin. Here’s the science: the mitochondria—essentially the engine—in cells need something called NAD+ to make ATP, which is the fuel that your cells run on. You need this ATP to do repair. Niacinamide supplies you with NAD+. The results are impressive—an increase in ceramides, which form the skin’s barrier; faster cell turnover; reduced oil production and inflammation. Niacinamide is proving to be a hero topical drug. When your cells are growing normally because they’re getting that fuel, they’re not sticking together and blocking your pores.
Can probiotics help clear your skin?
These are an exciting emerging option for treating acne both topically and orally. They work primarily by controlling inflammation, improving skin-barrier function and reducing acne-causing bacteria [Propionibacterium acnes]. You can look for them on the ingredient list on serums and moisturizers that you’d apply in the morning and night. (More here: Should You Be Using Probiotic Skin-Care Products?)
Are there prescription options?
One drug we’re starting to use for female hormonal acne is called spironolactone. It was originally designed as a blood pressure medication, so it’s made for long-term use and has 30 years of safety data. For acne, it impacts androgen [hormone] receptors in the sebaceous gland, causing it to produce less oil and improving acne symptoms.
What about life factors—how do they play into breakouts?
Exercise, sleep, diet, and stress—those are the biggies. Working out increases blood flow, so your tissues get more oxygen and nourishment. Sleep is when your cells repair themselves, so that’s crucial. It also helps you destress. (More here on the benefits of exercise for your skin.)
And diet is huge. Studies show that sugar and processed carbs drive insulin spikes, which trigger oil production and inflammation. Also, fat is your friend when it comes to your skin barrier. You need healthy fat for the ceramides, which protect you and keep your skin supple.
Any easy way to give your skin a boost?
I love anything that turns you upside down for a couple of minutes. It gets blood flowing to the head, and you end up with extra oxygenation of the tissues. (Enter: Handstands. Ok, or downward dog.)
How do you handle acne scars?
Retinoids are great for minimizing scars and those dark marks from breakouts. There are all types of in-office laser treatments that can reduce visible scarring. We use TCA Cross, a peel that treats scars specifically. It’s a strong acid [trichloroacetic acid] that injures the skin and lets scars fill in. We turn to the CO2 laser when we want to conduct skin resurfacing.
How does sunscreen affect breakouts?
Anyone on an acne treatment is sun sensitive, so sunscreen is very important. One of five people gets a skin cancer by age 70. These days, sunscreen is really skin care, packed with healthful ingredients, so it does your skin a favor in addition to blocking rays. Opt for one that’s labeled noncomedogenic. (And, yes, you should wear sunscreen even when you're indoors all day.)
Shape Magazine, May 2020 issue